학술논문
Impact of the COVID-19 Pandemic on Emergency Adult Surgical Patients and Surgical Services: An International Multi-center Cohort Study and Department Survey
Document Type
Academic Journal
Author
Winter Beatty, Jasmine; Clarke, Jonathan M.; Sounderajah, Viknesh; Acharya, Amish; Rabinowicz, Simon; Martin, Guy; Warren, Leigh R.; Yalamanchili, Seema; Scott, Alasdair J.; Burgnon, Elizabeth; Purkayastha, Sanjay; Markar, Sheraz; Kinross, James M.; Kinross, J.M.; Markar, S.; Clarke, J.M.; Winter Beatty, J.; Sounderajah, V.; Acharya, A.; Rabinowicz, S.; Yalamanchili, S.; Scott, A.J.; Martin, G.; Warren, L.R.; Burgnon, E.; Purkayastha, S.; Di Marco, A.; Sugand, K.; Sarraf, K.M.; Kulshreshtha, A.; Aseem, R.; Deurloo, E.K.; Quinnen, N.C.; DeLa Cruz, N.J.M.; Yiu, A.J.; Khan, N.; Markiewicz, O.; Goh, E.T.; Denning, M.; Aggarwal, R.; Mason, S.; Chidambaram, S.; Erridge, S.; Dryden, S.D.; Serban, O.; Vaghela, U.; Mechera, R.; Glover, A.; Papachristos, A.; Xuan, R.; Poels, D.; Tree, K.; Daniel, M.S.; Karim, S.; Islam, N.; Rahman Mitul, A.; Dhondt, B.; Azab, M.A.; Azzam, A.Y.; Balalis, D.; Fradelos, E.; Korkolis, D.P.; Skotsimara, A.; Baili, E.; Kyros, E.; Felekouras, E.; Vagios, I.; Karydakis, L.; Mpoura, M.; Syllaios, A.; Davakis, S.; Liakakos, T.; Charalabopoulos, A.; Manatakis, D.; Tasis, N.; Fulop, A.; Szijarto, A.; Khan, M.; Baba, A.; Nanda, S.; Bhat, J.; Parray, F.; Aziz, G.; Chowdri, N.; Wani, R.; Shah, Z.; Muzamil Andrabi, S.; Mehraj, A.; Fowler, A.L.; Chaudhary, A.; Murphy, B.; van der Hoef, D.; Ryan, E.; OʼBeirn, E.; Marzouk, F.; McKevitt, K.; Nizami, K.; Grewal, H.; Hennessy, O.; Roden, Y.; Elwahab, S.A.; Collins, C.; Hassanin, A.; Walsh, S.R.; Zafar, A.S.; Aherne, T.M.; Devine, M.; Toale, C.; Nally, D.M.; Ahmed, W.; Hannan, E.; Ullah, F.; Twyford, M.; Foley, N.; O’Donnell, O.; Peirce, C.; Da Roit, A.; Milana, F.; Marano, S.; Basato, S.; Castoro, C.; Fazzin, M.; Torchiaro, M.; Fabbri, N.; Feo, C.V.; Meima-van Praag, E.M.; Van Haeren, M.M.T.; Sharabiany, S.; Hompes, R.; Ingwersen, E.W.; Meijer, F.; Voeten, D.M.; Gisbertz, S.S.; Van Berge Henegouwen, M.I.; Lee, D.; Mason, B.J.; Stott, S.N.; Beamish, R.E.; Akinmade, A.; Fayose, E.; Alabi, K.; Larri, S.; Enoch, E.; Kayode-Nissi, V.; Okunlola, A.; Adeyeye, A.; Yusuf, A.; Shittu, A.; Irmiya, S.N.; Abdullah, J.; Qaiser, A.; Bilal, M.; Noman, A.D.; Bukhari, S.I.; Ciubotaru, C.; Negoita, V.M.; Stoica, B.; Negoi, I.; Ayed, S.; Alwade, H.; Aldaya, M.; Magboul, N.A.; Mushabab Ali, A.; Betoret, L.; Baeza, M.; Aguilar, J.; Hamid, H.K.S.; Eltayeb, M.; Awadelkarim, M.E.; Elbahari, H.; Yalcinkaya, A.; Sahin, C.; Yavas, M.; Yavuz, A.; Gobut, H.; Bostanci, H.; Sare, M.; Yuksel, O.; Kozan, R.; Altiner, S.; Leventoglu, S.; Kara, Y.; Aybar, E.; Can Sari, A.; Colak, E.; Harky, A.; Panda, A.; Popescu, F.; Abdulhakeem, M.; Al Nahian, S.; Kirmani, B.H.; Mahendran, B.; Goodworth, J.; Saxena, S.; Clark, J.; Truelove, A.; Penna, M.; Patel, N.; Marinos-Kouris, S.; De Jong, M.C.; Mihai, R.; Khan, S.; Van Den Heede, K.; Chander, N.; Palazzo, F.; Tolley, N.; Di Marco, A.; Law, J.; Papakonstantinou, A.; Vigneswaran, N.; Nikolaou, S.; Mangam, S.; Verstegen, M.H.P.; Greenfield, S.; Ezzat, A.; Day, A.; Ma, J.; Carswell, K.; Hall, R.; Maher, S.; Small, S.; Belgaumkar, A.; Parkins, K.; Spencer, N.; Egan, R.J.; Gowda, A.; Malcolm, F.L.; Bhatti, I.; Maqsood, M.; Daliya, P.; Richardson, S.; Klimach, S.; Pike, S.; Chia, Z.; Madhok, B.; Khalil, A.; Mirnezami, R.; Williams, K.J.; Owen, H.A.; Donald, N.; Buksh, M.; Ratnasingham, K.; Irukulla, S.; Varatharajan, L.; Trivedi, P.; Pearce, P.; Moussa, O.; Arhi, C.; Karagianni, C.; Borg, C.M.; Lee, L.; Erotocritou, M.; Mccluney, S.J.; Randhawa, S.M.K.; Parmar, C.; Selaru, H.; Khougali, H.S.; Suresh, J.; Nowak, K.; Conroy, M.; Elliott, M.; Ocana, N.; Ayoub, N.; Kabani, S.; Tryliskyy, Y.; Colucci, G.; Rooney, S.; Nandasena, M.; Balakrishnan, A.; Riley, L.; Rajagopal, P.; Hamrang-Yousefi, S.; Perikleous, Y.; Jawad, Z.A.R.; Pai, M.; Spalding, D.; Fehervari, M.; Hani, A.; Datoo, Z.; Wright, E.V.; Selmi, H.; Furey, J.; Ginnelly, L.; Somashekar, N.; Kalifa, R.; Nahas, S.; Ponugoti, N.; Aujayeb, A.; Murtada, A.; Pavithran, A.; Martin, E.; Raghunath, R.; Arulampalam, T.; Aladeojebi, A.; Barmayehvar, B.; Kobe, I.; Nair, N.; Rajagopalan, S.; Sadia, U.; Murali, V.; Gudaru, K.; Jaipersad, A.; Chandarana, K.; Kutywayo, K.; Caruana, E.; Aframian, A.; Morgan, C.; Flaherty, D.; Bray, E.; Rahman, K.; Pakroo, N.; Dela Cruz, N.J.M.; Lee, N.; Wharton, R.; Tanna, S.; Dattani, R.; Kabariti, R.; Khaleeq, T.; Rhee, J.; Hinsche, A.; Zhang, M.; Rowlands, E.; Smith, N.; Smith, C.; Mousa, A.; Lin, B.; Koutsouris, S.; Tan, Y.C.; Lee, G.; Clough, O.; Kutuzov, V.; Evans, D.; Davies, A.; Park, C.; Krishna, L.; Ogundere, D.; Judkins, N.; Malik, C.; Doe, M.; Ridgway, A.; Sudlow, A.; Grewal, A.; Finch, E.L.; Richardson Banks, H.J.; Quinn, M.; Brewster, O.; Dyer, S.; Choo, S.; El Jichi El Mutasem, T.; Browning, N.; Pournaras, D.J.
Source
Annals of Surgery. Dec 01, 2021 274(6):904-912
Subject
Language
English
ISSN
0003-4932
Abstract
OBJECTIVES:: The PREDICT study aimed to determine how the COVID-19 pandemic affected surgical services and surgical patients and to identify predictors of outcomes in this cohort. BACKGROUND:: High mortality rates were reported for surgical patients with COVID-19 in the early stages of the pandemic. However, the indirect impact of the pandemic on this cohort is not understood, and risk predictors are yet to be identified. METHODS:: PREDICT is an international longitudinal cohort study comprising surgical patients presenting to hospital between March and August 2020, conducted alongside a survey of staff redeployment and departmental restructuring. A subgroup analysis of 3176 adult emergency patients, recruited by 55 teams across 18 countries is presented. RESULTS:: Among adult emergency surgical patients, all-cause in-hospital mortality (IHM) was 3.6%, compared to 15.5% for those with COVID-19. However, only 14.1% received a COVID-19 test on admission in March, increasing to 76.5% by July.Higher Clinical Frailty Scale scores (CFS >7 aOR 18.87), ASA grade above 2 (aOR 4.29), and COVID-19 infection (aOR 5.12) were independently associated with significantly increased IHM.The peak months of the first wave were independently associated with significantly higher IHM (March aOR 4.34; April aOR 4.25; May aOR 3.97), compared to non-peak months.During the study, UK operating theatre capacity decreased by a mean of 63.6% with a concomitant 27.3% reduction in surgical staffing. CONCLUSION:: The first wave of the COVID-19 pandemic significantly impacted surgical patients, both directly through co-morbid infection and indirectly as shown by increasing mortality in peak months, irrespective of COVID-19 status.Higher CFS scores and ASA grades strongly predict outcomes in surgical patients and are an important risk assessment tool during the pandemic.